How Do You Fix a Nose with a Bulbous Tip?

By refining the tripod of cartilages that contribute to the bulbous shape.  This is done by resecting the tip cartilages, suturing them together and adding cartilages on top that are harvested from your septum or ear. 

The primary cause of a bulbous tip is excess cartilage that creates a sub-optimal shape. The procedure involves careful cartilage removal and reshaping. It is important to leave a strong framework in order to prevent collapse.  Some patients also have excess fatty tissue, which can be thinned out. However, overly aggressive soft-tissue thinning can impair blood supply, which can lead to severe complications.

Hello and thank you for your question. Tip refinement can be accomplished by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Hello,In a closed rhinoplasty approach, many different options are available depending on the nose. We can perform subtle refinements of the nasal tip through a scarless approach using endonasal techniques to size, shape and positioning of the nasal tip cartilages. Depending on your need we have an answer to address it with our closed scarless technique. Sometimes it's as simple as carving and sculpting your current cartilage.  Sometimes we need to reposition the tip cartilages with delivery and suture techniques.  Sometimes we need to use small grafts to enhance the projection or rotation of the tip. Consult with a board certified facial plastic surgeon for a consultation to see exactly what procedure you want and need. All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

The bulbous tip usually has excess cartilage. It can be trimmed and the skin shrinks to adapt to the new smaller cartilage structure. In some cases there is excess fat in the tip especially in African American noses. Removal of the excess fat also helps the bulbosity. RegardsDr. Janjua

Fixing a bulbous tip can be one of the most challenging aspects of rhinoplasty surgery.  The cartilages which lie underneath the tip of the nose generally have to be reshaped in some way. These cartilages cannot be removed or significantly excised, as it tends to cause complications. Instead these cartilages can be sutured in various ways or often have additional cartilage added in the area to allow for re-shaping.
One of the greatest challenges is the skin thickness.  If the skin of the tip is thick, it tends to be difficult to really show any changes to the underlying cartilage because the skin simply 'covers it up".  If skin is too thin it can also be challenging as small changes in the underlying cartilages can be visible and show thru.
It is very important to have a clear discussion with your surgeon as to what type of a result you can expect. You can ask if additional cartilage or other material is going to be added to the tip.  Also important to choose an experienced rhinoplasty surgeon who has performed surgery on similar ethnicities as your own. 
Hope that helps and good luck. 

Rhinoplasty is one of the most difficult facial plastic surgery procedures and refining the tip is the most complex part of rhinoplasty. In the case of a bulbous nose tip, this can be caused by a variety of factors, but usually starts with cartilage that is broad and too widely spaced. I would usually approach this is an open manner, shave down the cartilage and suture it together. If the overlying skin is very thick, it will need to be thinned.  At times the cartilage is mal positioned and overly curved.  In this case, the cartilage will need to be reoriented and straightened with cartilage grafting. The exact procedures necessary will depend on the patient's anatomy and what he or she hopes to achieve. Whether the patient is Caucasian, African-American, Asian, or another ethnicity may also influence the surgery, as anatomy and cartilage composition can vary considerably among the races. Please find a facial plastic surgeon with expertise in tip anatomy. I hope this helps.

We prefer an open approach, and tip narrowing in our practice typically involves dividing the lower lateral cartilages, and trimming excessive tip cartilage that may be leading to a bulbous appearance.Hope this helps.Dr Joseph

Hi,The tip cartilages are very thin, but they are arched, and if the arches are wider, then then the tip will look wider. There are various ways to change the position and shape of the cartilages to narrow the tip.The Web reference link below goes to the first page of an essay I wrote on narrowing the tip of the nose. Careful, though, because there are photos taken during surgery, although not on the very first page of the essay.

A bulbous tip is caused by wide cartilages that are poorly shaped. Converting a bulbous tip to a more shapely and defined tip requires Carving the cartilages to a more slender shape and then suturing (connecting them with surgical threads) them together To narrow them and further refine their shape while also maintaining their strength and integrity. One of the biggest limitations to a more defined tip is simply the skin. Unfortunately, we can make the inside of the nose as small as possible but the Overlying skin needs to contract around the cartilage underneath. If it doesn't, the nose continues to look on shapely, much like wearing an extra-large sweater after losing 40 pounds.